Upper Airways/Larynx

Question 1

Definitions of main types of abnormal airway sounds

Answer 1

• Hoarseness = abnormal voice changes, breathy, raspy, strained, weak
• Dysphonia = general alteration of voice quality. Usually a laryngeal source
• Dysarthria = defect in rhythm, enunciation, articulation. Usually a neurological or muscular source
• Stridor = large airway noise from obstruction
• Stertor = snoring sound from nose, nasopharynx, throat
• Wheezing = pulmonary from smaller airways

Question 2

Location of obstructions causing stridor

Answer 2

• Inspiratory – supraglottic, extrathoracic
• Expiratory – tracheal, large bronchi intrathoracic
• Biphasic – laryngeal, immediate subglottis

Question 3

Hoarseness causes

Answer 3

• Viral laryngitis – acute
• Reflux - chronic
• Vocal abuse
• Allergies, PND
• Chronic cough
• Nodules/

Polyps/

Trauma

• Age
• Neurological disorders
• Smoking
• Malignancies of thyroid, larynx, lungs

Question 4

Layers covering vocal folds

Answer 4

• –Epithelium
• –Superficial Lamina Propria
• –Intermediate Lamina Propria
• –Deep Lamina propria
• –Vocalis muscle (medial thyroarytenoid)

Question 5

Components of voice production

Answer 5

• source= pulmonary (infraglottic)
  
  • diaphragm, intercostal msucles
• vibratory production = laryngeal
  
  • extrinsic & intrinsic muscle
• resonance
  
  • supraglottic
  • oral phase
• MSK/abdominal muscles = support system & some control
• ANS impact mucus prduction/voice stability

Question 6

Extrinsic muscles that control the vocal folds + fxns

Answer 6

• strap muscles ==> ansa cervicalis, C1-3
• infrahyoid
  
  • thyrohyoid
  • sternothyroid
  • sternohyoid
  • omohyoid
• suprahyoid
  
  • digastric
  • mylohyoid
  • geniohyoid
  • stylohyoid

Question 7

Extrinsic muscles fxn

Answer 7

• help maintain position of larynx in neck
• help produce consistent sound
• change tension, position, tilt ==> changes resting length of intrinsic muscles

Question 8

Anatomy of laryngeal skeleton (important cartilages)

Answer 8

–Thyroid –Cricoid –Paired Arytenoids

Question 9

Intrinsic muscles of vocal folds

Answer 9

• various ligaments
• cricoarytenoid? ==> triangular membrane
• vocalis?
• thyroarytenoid + aryepiglottic fold ==> quadrangular membrane

Question 10

Central innervation of the vocal folds

Answer 10

• –Speech area of temporal cortex
• –Voice area of precentral gyrus
• –Corticobulbar tract
• –Nucleus ambiguus
• –Cranial nerve X and spinal cord
• ==>Coordinates laryngeal muscles, sensation, abdominal musculature

Question 11

Vagus branch innervation of vocal folds

Answer 11

• Superior Laryngeal Nerve
  
  • –Internal Branch = Sensation
  • –External Branch = Motor to Cricothyroid Muscle (CT)
• Recurrent Laryngeal Nerve – all intrinsic muscles but CT

Question 12

Mechanics of sound production

Answer 12

• vibrator = vocal folds ==> control frequency
• resonator = vocal tract (oral cavity/ oropharynx) ==> controls sound quality
  
  • length impacts frequencies ==> shorter tract = higher fundamental frequencies

Question 13

Causes for concern w/hoarseness

Answer 13

• If hoarseness lasts longer than 2-3 weeks
• If hoarseness is associated with:
  
  • –Pain, note ear radiation possible
  • –Coughing up blood
  • –Difficulty swallowing
  • –A lump in the neck
  • –Complete loss or severe change in voice lasting longer than a few days

Question 14

Characterististics of paralyzed/immobile vocal folds

Answer 14

• Lesion w/in nerve pathway possible
• w/u includes CT scan of skull base through aortic arch with contrast
• Laryngeal EMG

Question 15

Laryngopharyngeal reflux definition

Answer 15

escape of stomach acids from the stomach into the esophagus through the LES. May reach the larynx, oral cavity and lungs.

Question 16

LPR symptoms

Answer 16

• Hoarseness
• Chronic cough
• Foreign Body sensation (globus)
• Tracheal Stenosis
• bad breath or bitter taste in a.m.
• a.m. hoarseness or after meals
• sensation of post-nasal drip but no nasal issues
• heartburn not always present